Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
Sure, because there job is to ease the monetary burden of suffering events. That doesn't mean they have to act like they do.
The real problem in the US is most people are not the customer for their health insurance - their employer is. In theory I can buy heath insurance from someplace other than my company, but I'm throwing away $1000/month (more or less - it is hard to find the real number) that I'd have to find if I went elsewhere. That means either insurance I get on my own is worse than what I have, or I have a lot less money for other things.
Which is why I've long said that to solve the US problems we need to remove the tax breaks for company sponsored health insurance. Once that happens I can actually decide which insurance company is the best for me.